Are low payment rates the reason physicians don't take Medicaid payments? MACPAC seeks to answer that question in MACPACs first issue brief of the new year.
Medicaid physician payment rates are increasingly gaining the attention of lawmakers, so...
The Centers for Medicare & Medicaid Services (CMS) is reporting another record year for ACA plans with 23.6 million consumers across the country choosing a 2025 health plan during the Marketplace Open Enrollment Period (OEP); nearly 3.2 million new shoppers have already chosen a plan and there's still time, the OEP ends January 15,...
Arizona's Medicaid agency expects to help incarcerated individuals coordinate healthcare services upon reentry into the community to improve coordinated access to healthcare care services, improve health outcomes, and reduce recidivism.
To qualify for services, individuals must reside in a correctional facility and determined eligible...Arizona News
Several state Medicaid directors recently indicated that mid-year rate adjustments will help address concerns raised by Medicaid managed care plans about rising costs. These concerns stem from managing beneficiaries with higher acuity and increased healthcare utilization following the unwinding process.
At the November NAMD...
Medicare Advantage insurers are still defrauding the Medicare program by inflating patient diagnostic codes. This week, one company settles with the federal government and another gets found out.
New York Medicare Advantage (MA) insurer Independent Health Corporation and it's (now defunct) subsidiary DxID ended their 12 year legal...
On the way out the door, the Biden administration's Department of Health and Human Services (HHS) launched a campaign to combat misinformation and increase childhood vaccine uptake as President-elect Donald Trump's anti-vaccine allies are poised to take over.
The campaign, Let's Get Real, is designed to "cut through the noise" of...
This week, an editorial from JAMA Network explores the challenges of disentangling the cost shifting between Medicare and the Veteran's Affairs (VA) system as more MA members use VA healthcare services.
The Veteran's Affairs health system is vast and supports nearly 10 million enrollees with a wide array of facilities and specialized...
Perinatal mental health conditions are one of the leading causes of maternal mortality, or death within a year of pregnancy in Arizona.
The Arizona Center for Investigative Reporting found that prenatal mental health screenings are an effective tool for early intervention into pregnancy-related and postpartum depression, but Arizona...National News
After disruption from President-elect Donald Trump and his close advisor and businessman Elon Musk, the U.S. House of Representatives passed a debt ceiling measure that included an extension of some health programs and a continuing resolution to keep the government open until March 14, but dropped provisions that would have regulated...
President-elect Donald Trump's cabinet nominations are proceeding with little Republican pushback as Secretary of Health and Human Services (HHS) nominee Robert F. Kennedy, Jr. (RFK) spent the week visiting the offices of friendly Republican senators. Solicitor general nominee John Sauer and Centers for Medicare and Medicaid Services...
End-of-year presentations by The Medicare Payment Advisory Commission (MedPAC) provide readers data and analysis of 2023 payments and future 2025 payments for outpatient dialysis, hospice, home healthcare, inpatient rehabilitation, skilled nursing, hospital outpatient billing, rural emergency hospitals and physician and other health...
Rising consumer healthcare costs and increasing commercial reimbursement rates, impacts of the IRA, along with MSSP & REACH ACO shadow bundles and MA agent compensation data - if you can measure it, Milliman had an article, news brief or white paper on it in 2023; we're highlighting a few of our newsroom favorites.
Milliman is a...
This data edition offers a critical snapshot of Arizona’s hospitals and health systems, providing key insights into financial performance, market footprints, and quality ratings that are shaping the future of care in the state.
In this exclusive data edition, members of The Hertel Report will find comprehensive data on hospital...
Healthcare was barely mentioned during the 2024 election cycle, but there are major policy decisions to be made early next year that will have major impacts across the industry.
While Medicaid was almost never mentioned, there are glaring vulnerabilities to the program as President-elect Donald Trump threatens severe cuts to federal...
The Centers for Medicare and Medicaid Services (CMS) launched its nursing home staffing campaign to support compliance with the nursing home staffing minimum rule. The support includes new websites designed to facilitate recruitment and education for new nurses.
The websites aren't a provision of the staffing mandate but an additional...
The costs were also unprecedented for the CMS Innovation Center's models, driven primarily due to risk score growth and prescription drug costs that could not be contained by policy modifications.
The costs are "substantial and unmitigable," exceeding $2.3 billion in 2021 and $2.2 billion in 2022, according to the CMS Blog post on...
The Steward Health Care debacle has drawn public focus to the participation of private equity (PE) in health care. As PE seeks to raise value for shareholders as quickly as possible by any means, it can have calamitous effects on crucial services and the communities that rely on them.
In short, private equity firm Cerberus Capital...
The Centers for Medicare and Medicaid Services (CMS) published its analysis of maternal and perinatal health outcomes in live births covered by Medicaid and the Children's Health Insurance Program (CHIP) for 2021.
The data brief is part of the CMS effort to tackle health disparities and worsening maternal health outcomes in the U.S.,...
A year-end drama is raging on Capitol Hill as Republican lawmakers debate raising the debt ceiling in a major piece of budget legislation that includes concessions to Democrats including healthcare policies like telehealth and pharmacy benefit manager (PBM) regulation.
Late Wednesday, President-elect Donald Trump and Vice...
In a clear recognition of the escalating threat posed by bird flu, California Governor Gavin Newsom declared a state of emergency on Wednesday due to the outbreak of infections among the state's dairy cattle.
The move came shortly after reports revealed that a Louisiana resident had been hospitalized with bird flu—marking the first...
The House AI Task Force authored the report intended to serve as a blueprint for future actions that Congress can take to address advances in AI technologies.
AI Adoption in the Healthcare System - Highlights From the Report
Use of AI in Drug Development
The average cost of developing and bringing a new drug to market is...
The incoming Trump administration has been unclear about its vision for the Medicare program, but the president-elect has encouraged lawmakers to start making cuts, which goes hand-in-hand with bolstering the interests of private insurers. But public sentiment does not view health insurance favorably, so what's the alternative?
While...
Public support for Medicare is strong, while Medicare Advantage represents half of all Medicare beneficiaries. The differences between these programs require adjustment through policy as the solvency of the Trust Fund comes into question and Medicare spending becomes a target for a new administration that has pledged austerity.
The...
With public perceptions of health care grabbing headlines, Gallup released two relevant polls showing that most Americans believe that healthcare is the government's responsibility and the quality of healthcare in the country isn't very good.
The highest number of Americans in a decade (62%), including Republicans (32%) answered...
A new study from the Kaiser Family Foundation (KFF) looked at spending trends among people who chose to disenroll from Medicare Advantage during the Medicare open enrollment period and found a difference of $2,585 (27%) in Medicare spending per person, on average, between the two groups in 2022.
Medicare beneficiaries with pneumonia...